Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2009 Aug 10:8:192.
doi: 10.1186/1475-2875-8-192.

Varying efficacy of artesunate+amodiaquine and artesunate+sulphadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in the Democratic Republic of Congo: a report of two in-vivo studies

Maryline Bonnet  1 , Ingrid van den Broek, Michel van Herp, Pedro Pablo Palma Urrutia, Chantal van Overmeir, Juliet Kyomuhendo, Célestin Nsibu Ndosimao, Elizabeth Ashley, Jean-Paul Guthmann
Affiliations
Clinical Trial

Varying efficacy of artesunate+amodiaquine and artesunate+sulphadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in the Democratic Republic of Congo: a report of two in-vivo studies

Maryline Bonnet et al. Malar J. .

Abstract

Background: Very few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC). DRC changed its anti-malarial treatment policy to amodiaquine (AQ) and artesunate (AS) in 2005.

Methods: The results of two in vivo efficacy studies, which tested AQ and sulphadoxine-pyrimethamine (SP) monotherapies and AS+SP and AS+AQ combinations in Boende (Equatorial province), and AS+SP, AS+AQ and SP in Kabalo (Katanga province), between 2003 and 2004 are presented. The methodology followed the WHO 2003 protocol for assessing the efficacy of anti-malarials in areas of high transmission.

Results: Out of 394 included patients in Boende, the failure rates on day 28 after PCR-genotyping adjustment of AS+SP and AS+AQ were estimated as 24.6% [95% CI: 16.6-35.5] and 15.1% [95% CI: 8.6-25.7], respectively. For the monotherapies, failure rates were 35.9% [95% CI: 27.0-46.7] for SP and 18.3% [95% CI: 11.6-28.1] for AQ. Out of 207 patients enrolled in Kabalo, the failure rate on day 28 after PCR-genotyping adjustment was 0 [1-sided 95% CI: 5.8] for AS+SP and AS+AQ [1-sided 95% CI: 6.2]. It was 19.6% [95% CI: 11.4-32.7] for SP monotherapy.

Conclusion: The finding of varying efficacy of the same combinations at two sites in one country highlights one difficulty of implementing a uniform national treatment policy in a large country. The poor efficacy of AS+AQ in Boende should alert the national programme to foci of resistance and emphasizes the need for systems for the prospective monitoring of treatment efficacy at sentinel sites in the country.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Location of study sites.
Figure 2
Figure 2
Details of inclusions and follow-up in thestudies in Boende and Kabalo.
See this image and copyright information in PMC

References

    1. World Health Organization World malaria report 2008. Country profile by WHO region. WHO Geneva. doi: 10.1111/j.1365-3156.2006.01710.x. - DOI
    1. Swarthout TB, Broek IV van den, Kayembe G, Pota H, Roper C. Artesunate + amodiaquine and artesunate + sulphadoxine-pyrimethamine for treatment of uncomplicated malaria in Democratic Republic of Congo: a clinical trial with determination of sulphadoxine and pyrimethamine-resistant haplotypes. TMIH. 2006;11:1503–1511. doi: 10.1111/j.1365-3156.2008.02150.x. - DOI - PubMed
    1. Alker AP, Kazadi WM, Kutelemeni AK, Bloland PB, Tshefu AK, Meshnick SR. dhfr and dhps genotype and sulfadoxine-pyrimethaminetreatment failure in children with falciparum malaria in the Democratic Republic of Congo. Tropical Medicine and International Health. 2008;13:1384–1391. doi: 10.1016/S0140-6736(98)24022-0. - DOI - PMC - PubMed
    1. Kublin JG, Witzig RS, Shankar AH, Zurita JQ, Gilman RH, Guarda JA, Cortese JF, Plowe CV. Molecular assays for surveillance of antifolate-resistant malaria. Lancet. 1998;351:1629–1630. doi: 10.1016/j.meegid.2004.04.002. - DOI - PubMed
    1. Talisuna AO, Nalunkuma-Kazibwe A, Langi P, Mutabingwa TK, Watkins WW, Van Marck E, Egwang TG, D'Alessandro U. Two mutations in dihydrofolate reductase combined with one in the dihydropteroate synthase gene predict sulphadoxine-pyrimethamine parasitological failure in Ugandan children with uncomplicated falciparum malaria. Infect Genet Evol. 2004;4:321–327. doi: 10.1016/j.meegid.2004.04.002. - DOI - PubMed

Publication types